DOI: 10.1161/circ.148.suppl_1.14844 ISSN: 0009-7322

Abstract 14844: Coronary Artery System Dominance Influences the Distribution of Calcified Plaques in Coronary Tree

Leili Pourafkari, April Kinninger, Venkat Sanjay Manubolu, Hooman Fazlalizadeh, Keishi Ichikawa, Jairo Aldana, Sion Roy, Matthew J Budoff
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Left dominant coronary system associates with worse prognosis likely due to less well-balanced myocardial perfusion. Larger proportion of coronary flow enters left coronary in left dominant systems potentially leading to higher shear stress. In left dominant coronary systems, resultant alterations in flow hemodynamics could affect development of calcified plaques in left anterior descending artery (LAD).

Hypothesis: Coronary artery dominance with resultant alterations in blood flow hemodynamics in coronary arteries could affect the distribution of calcified plaques in the coronary tree

Methods: We performed a large retrospective single-center cohort study, including consecutive patients who underwent CTA from September 2006 to December 2022 in Los Angeles, California to determine whether left dominant coronary anatomy was associated with higher LAD calcium percentage (LAD calcium score divided by total calcium score) compared to right dominant coronary system. Subjects with coronary artery calcium score (CAC) above zero were enrolled. Multivariable linear regression was used to evaluate the association between the LAD calcium percentage by subjects with left versus right coronary system dominancy.

Results: Among the cohort of 9,560 subjects,6,796 subjects had with CAC above zero. The average age was 64.8±10.7 years, 68% male, and 9% had left dominant coronary systems. Controlling for age, gender, BMI, hyperlipidemia, hypertension, family history of cardiovascular disease and past smoking, those with a left dominant coronary system had 10.1% higher (CI 7.5%-12.8%, p<0.001) percent of calcium localized in LAD than those with right dominant systems (Table 1)

Conclusions: Coronary system dominance affects the distribution of atherosclerotic burden. Left dominant coronary system compared to right dominant coronary system is associated with higher percentage of calcified plaques localized to LAD.

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